Tava Health

Credentialing Specialist

• Oversee delegated credentialing activities for an assigned payer portfolio, including readiness reviews, ongoing compliance monitoring, recurring reporting, and annual audits
• Monitor NCQA guidance, state regulations, and accreditation updates; assess operational impact and implement compliance changes
• Prepare for and facilitate pre-delegation and annual credentialing audits; develop and track corrective action plans through resolution
• Maintain complete, audit-ready credentialing records, including primary source verification, Credentialing Committee documentation, and adverse action logs
• Prepare recurring deliverables for delegated partners and payers, such as provider rosters, audit materials, and credentialing activity reports
• Monitor average time to credential, identify delays, manage follow-up, and escalate issues as needed
• Partner with Enrollment, Partnerships, Revenue Cycle, Legal/Compliance, and other teams to maintain accurate provider data and reconcile internal records against delegated payer rosters
• Serve as a point of contact for payer communications related to delegated credentialing activities, audits, provider records, and follow-up items
• Support implementation of new delegated credentialing agreements, including processes and controls for contractual requirements
• Lead Credentialing Committee meetings, including preparation, execution, minutes, training materials, records, and follow-up
• Lead credentialing for Nurse Practitioners, including application review, primary source verification, committee readiness, payer submissions, follow-up, and status tracking
• Support credentialing for group practice providers by coordinating documentation, resolving application gaps, monitoring timelines, and maintaining accurate provider records